Lead, a common element found in nature, serves no biologic function; the human body has no need or use for it. However, an elevated lead level is known to adversely affect growth and development, and to damage the kidneys and the CNS. Young children under the age of six are at risk as they tend to put hands and objects into their mouths, increasing the chances of entry of lead dust into their systems. Screening for lead and prompt care has virtually eliminated the incidence of “lead encephalopathy,” a major cause of death among children 30 years ago (NYSDOH, 2001).
According to The current BPb (blood lead) intervention level that warrants action on behalf of NYS pediatricians is 10 Ã?Âµg/dL. Since 1970, the US Centers for Disease Control and Prevention (CDC) has set tiered screening and intervention levels for childhood lead poisoning with the purpose of guiding federal, state and local health departments through funding of budgets to identify and properly respond to lead exposed children. The intervention level which was originally set at 40 Ã?Âµg/dL, has progressively been lowered from 25 Ã?Âµg/dL to 10 Ã?Âµg/dL in 1991 as new research findings are made (CDC, 1991).
The 1997 CDC guidance document recommends targeting blood lead screening and interventions to high-risk areas. State public health officials receiving lead poisoning prevention grants must develop statewide plans for either performing universal screening or requiring screening for (1) higher-risk areas within the state identified through housing stock age or a prevalence of BLLs of 10 Ã?Âµg/dL or higher; (2) children who receive services from public assistance programs such as Medicaid; and (3) children whose parents or guardians provide responses to a personal risk questionnaire that indicate elevated risk of lead exposure, or who lack sufficient knowledge to answer a personal risk questionnaire.
Many states have screening statutes in place. For example, New York is a universal lead screening state with Department of Health statutes that require pediatricians to screen all one and two year-olds for elevated blood lead (BPb) levels as part of routine well child care visits. Pediatricians are also required to assess all children six months to six years of age for risk of high-dose lead exposure and to provide lead screening for those found to be at risk. There are several challenges facing New York that support the decision to universally screen for lead. New York has the highest amount of housing structures built before 1950 in the nation (NYSDOH, 2001). The federal Department of Housing and Urban Development estimates that 75% of pre-1950 housing contain lead paint. Another challenge facing NY is the great number of its children that live in poverty: more than 627,000 children under six years of age were eligible for Medicaid benefits during 1998. Due to their socioeconomic level, these children are more likely to live in older, deteriorating housing with lead paint hazards.
In populations with lower prevalence, the cost per case detected using targeted screening is less than that of universal screening: making the need for detecting a greater number of cases to be weighed against the extra cost of screening. In their cost-effectiveness analysis of lead poisoning screening strategies, Kemper et al. found such universal screening to detect all cases of lead poisoning and to be the most cost-effective strategy in high prevalence populations such as New York.
Kemper AR., Bordley WC, Downs SM. Cost-effectiveness Analysis of Lead Poisoning Screening Strategies Following the 1997 Guidelines of the Centers for Disease Control and Prevention. Arch Ped Ad Med. 152(12):1202-1208,1998.
Protecting Our Children from Lead: The Success of New York’s Efforts to Prevent Childhood Lead Poisoning. New York State Department of Health; 2001. Accessed online: http://www.health.state.ny.us/nysdoh/lead
Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials. Atlanta, Ga: Centers for Disease Control and Prevention; 1997. Accessed online: http://www.cdc.gov/nceh/lead